Joan and Dennis

Depression can place a huge strain on close relationships. Yet, Dennis and Joan's struggles with depression have brought them closer together.

Their story also shows that the fight against depression is an ongoing battle that requires incredible determination. Joan and Dennis have suffered chronically, Joan with major depression and Dennis with bipolar disorder. It took them decades to find treatments that now work. They have experienced setbacks, hospitalizations, job losses, and financial difficulties. Six years ago, Dennis and Joan met at a support group that Dennis facilitated. They got married last year in a poignant celebration that marked newfound stability and wellness. Their compassionate understanding of one another's illness, a common Irish Catholic upbringing, and a strong will to recover, have united them. They share their experiences and how they cope by simplifying their lives and lowering expectations.

Joan

How were you diagnosed with depression?

I was depressed in college, but I never sought treatment until I was 25 years old and working as a research assistant. We had weekly staff meetings where we went around the room and reported on our activities. I became so nervous when it was my turn to speak. My heart would beat so fast that I felt like people could see it. I felt so ridiculous that I couldn't talk to my coworkers.

My social anxiety grew and I just couldn't stand to be around people. I felt anxious, guilty, and worthless. I slept all the time. I was very tired. I had no appetite for anything and no interest in life. I just felt numb. I became overwhelmed and thought of ways out.

I complained to my general practitioner about my symptoms and she suggested that I see a psychiatrist. The psychiatrist said I was definitely depressed and put me on an antidepressant. I was lucky, I got treatment right away and the antidepressant initially worked quickly.

I've been on various antidepressants since then and was hospitalized once. I definitely need medications and probably will have to take them the rest of my life. The problem is that I need higher and higher doses. It is hard to find something that works for a long period of time.

How did you feel about your diagnosis? I was very relieved. I didn't know what was wrong with me. I thought my symptoms were unique to me and that I was very unusual. I was hopeful after learning that depression is a medical condition and there are treatments for it.

How do you feel now? I feel a lot better, but now I can see how far behind I am. I lost a lot of time just being depressed. I am behind in my career. I don't have kids, I don't own a house, and I don't have savings. I feel like an adolescent in my social development.

How does Dennis help you? Dennis is great because he is a no-pressure person. Other people worry about me and I feel it is my job to stop their worrying. If I sleep for a weekend, Dennis is concerned, but he has been through it and a lot worse.

When I start to feel better, I want to make extensive plans and changes. Dennis is good about lowering my expectations. A lot of my ideas involve risks, like moving or quitting my job. Dennis prevents me from going too far in case I get sick again.

Why does your relationship work? My relationship with Dennis is the best one I've ever had because he understands my depression. I have never experienced mania and have no idea what it's like, but there are similarities between our mood disorders.

Dennis and I have the same political leanings and upbringing. We both come from Irish Catholic families with grandparents from Ireland. We think very much alike.

What about children? We've decided not to have children. Dennis and I are very concerned that genetically, our child would have a high chance of having a mood disorder. We also worry about whether or not we could handle taking care of a child.

How have your parents reacted? My parents love Dennis. They saw an improvement in me after I stopped living alone and started living with Dennis. My parents do wonder if we are going to have children. They have almost forgotten that we have depression and treat us like a normal couple.

What misconceptions do people have about your condition? People don't realize that there are so many people among them with depression. When Dennis mentions that he is a support group leader, people usually tell us that they have a family member with depression. Depression is very prevalent, but you can't see it.

What is your advice to others? Hang in there and keep trying. There are many antidepressants and new ones are constantly coming out, so don't give up. Be very kind to others in your relationships. We have a lot of friends with depression from our support group and the truth is that you can never count on them. Sometimes it is just the hardest thing in the world for depressed people to get out of bed and get dressed. You need to be very forgiving. Accept people for who they are instead of waiting for them to get better in order to love them.

Dennis

How did you discover that you have bipolar disorder?

I was 23 years old and was in the Peace Corps in Malaysia. For about three months, I had a lot more energy than usual. I wasn't sleeping much. I felt very creative, and started writing a play. I felt fine. I could have continued that way or returned to normal, but suddenly in the snap of a finger, I became absolutely psychotic. I was sitting with friends and I asked them to stay with me. I thought that I was having a religious experience. I felt that I had learned all the secrets of the world, and yet I couldn't quite articulate them. Then I became irritated with people because they couldn't see what I knew.

I stopped sleeping, left my apartment, and started wandering. I met wonderful people, like a cab driver who drove me for free. I met people and thought that we were immediately bonding. I thought that I was preaching to them and that we were all getting along.

Finally, I went to the Peace Corps office because I wanted to tell them how wonderful I felt. Immediately, they took me to a hospital. But even then I didn't think I was ill. I thought the doctors were going to study me because I was so unique and that I had a lot to teach them. Even though we didn't speak the same language, I tried to teach them.

I was transferred to a hospital in Washington D.C. After three months, I started coming down and I thought I had the flu. At that point the doctor said I was better and could go home. It was 1970. I asked the doctor what I had and he said 'I don't want to label you.' I responded that I'd like a label. I didn't understand what was happening.

After I was released, I felt very depressed and had suicidal thoughts. I didn't want to talk to my friends even though I had just come home. It was apparent to everyone that I had changed. I still didn't know what was wrong with me. Finally after some months, I told the doctor what was happening and he told me I was depressed and was manic-depressive. This was seven or eight months after the initial psychosis. I went back into the hospital and was put on antidepressants. A month later I was out of the hospital and back to my old self again.

How did your condition deteriorate? After my initial recovery, I went back to school to get a masters degree in engineering. The medications were transparent, except for a little dry mouth. I told the doctor that I was better. I thought it was over. No one told me manic depression is for life. The doctor took me off the medication. Within weeks I was depressed again.

I went through another cycle where the medication was transparent. I told the doctor that I was better and he took me off the medication. Again, I got depressed. But this time, the medication didn't work when I went back on. After a while, none of the medications worked. I had difficulty with medications for 20 years. One medication worked for eight years, then stopped. For five more years, I tried to find something. Sometimes I'd have a blip of mania, be hospitalized, then become immediately depressed.

My life fell apart. I lost my job. I had a real suicide attempt. I kept trying to find a treatment that would work. Finally in 1990, a different doctor gave me a new mood stabilizer plus an antidepressant. Within a month, I was feeling better. I went back to school and got another masters degree. It took two years to completely recover and get the dose right.

How did you feel once you finally recovered? All of a sudden a lot of emotions and feelings came up. I felt very sad over what happened to me. I felt like I woke up a new person and wondered how I became that way. I wanted to escape that feeling. A similar experience happened to a friend of mine. My friend recovered and said, 'Now I'm really depressed. I'm living on someone else's porch. I've lost my job and my family. I don't have anything. I wish that I were depressed again because all I had to think about was one thing: getting through the day without killing myself. Now I have to make choices and think about possibilities and a future that I never thought I could have.'

It's hard to deal with how devastating this illness can be, even though I have periods of doing well. Doing well are long-fought battles for years and years. These periods are a gift that can be taken away.

How have you adjusted your lifestyle? I had a good therapist who pointed out that I had too much stress in my life. I was trying to pretend that I didn't have this condition and wouldn't make any concessions to it. I was a design engineer, taking all the pressure that this job would normally take. I was folding under it. The therapist finally made me aware that the job I was doing was detrimental to my health. I had to find ways of taking stress out of my life. Leading support groups as a volunteer MDDA Boston (now DBSA-Boston) at the MDDA became my job.

Both Joan and I have taken a lot of stresses out of our lives, stresses that can put you over and send you into the hospital. We've had to lower our expectations in life. I've lost everything a number of times, as has Joan. Knowing that, we are not that attached to our possessions and we can get through pretty much anything. I realize that we're kind of coasting now, but that could change. I'm grateful for the boring times. I don't crave danger or action, because I know that it can come and tear things up. Stability used to be something that wasn't in my vocabulary.

How are support groups helpful? I have been leading support groups for 11 years. Usually when people first come to a group, their reaction is 'I'm home, I've found people that finally understand me.' The first day in most support groups is an immediate relief. There is a profound recognition and connection to other people that really drives the group. People feel like they can finally breathe, relax, and be with other people in way they haven't been able to before. When someone else is talking, you identify with it, because it resonates with an experience that you have had. You don't have to speak, all you have to do is listen and make connections.

How does your relationship with Joan work? My love is not predicated on Joan getting better. I saw Joan for what she was and she would say, 'how can you love me like this?' I was married before and when I was depressed, I felt an inability to love. But my previous wife still loved me and that made me feel guilty and horrible because I couldn't reciprocate.

I've have days when I'm depressed and Joan understands, she doesn't try to make demands of me. I find it difficult now to see how I could live with someone who didn't have the illness and didn't have this intimate knowledge of it.

Joan and I went to Paris in the first few years we met and Joan was really depressed. I didn't try to get her to go out. Having that understanding was invaluable. I didn't say, "pull yourself together, you need to get out, you can do it, it's all in your head". Depression is achy, it's all through you, and it invades every part of your psyche. If a partner doesn't understand that, it causes tension in the relationship.

How has your family responded? Before our wedding, my family kept my condition a secret. They pretended that they didn't know and I pretended that I didn't have it. Then, a former minister that I work with at the MDDA support group married us. Out of 100 people, 25 were friends from MDDA. The minister announced to the entire congregation that we had depression. It eliminated the pressure on pretense. If there was someone in the family that didn't know about my condition, they knew it at the wedding.

What misunderstandings do people have? Many people don't realize that depression is episodic and you can be perfectly normal in between episodes. There are times when everything is working and you're as normal as the next person. We're nothing to be feared.

What advice do you have? First, stay on your medication regime; if you start feeling well it is because of the medication. Don't give up; sometimes every day is such a battle. The difficult part of this illness is that your thought processes are incorrect, they seem real to you. You really do feel worthless, it does seem that you'll never get out of this, and that the only way out is to kill yourself. But this comes from faulty thinking from the illness. It seems real to the depressed person, but it is not reality. At all costs, try to hang on and believe that you can get well.